Research Article
The Impact of an Implementation Project on Primary Care
Staff Perceptions of Delivering Brief Alcohol Advice
Hanna Reinholdz,
1
Preben Bendtsen,
2
Fredrik Spak,
1
and Ulrika Müssener
3
1
Unit of Social Medicine, University of Gothenburg, 405 30 Gothenburg, Sweden
2
Department of Medical Specialist and Department of Medical and Health Sciences, Link¨ oping University, 581 83 Motala, Sweden
3
Department of Medical and Health Sciences, Link¨ oping University, 581 83 Link¨ oping, Sweden
Correspondence should be addressed to Ulrika M¨ ussener; ulrika.mussener@liu.se
Received 18 April 2016; Revised 2 June 2016; Accepted 5 June 2016
Academic Editor: Gallus Bischof
Copyright © 2016 Hanna Reinholdz et al. Tis is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly
cited.
Objective. To explore how the perceptions and experiences of working with risky drinkers change over time among primary health
care staf during a systematic implementation project. Methods. Qualitative focus group interviews took place before and afer
the implementation of the project. Results. Te staf displayed a positive change during the implementation period with regard to
awareness, knowledge, and confdence that led to a change in routine practice. Troughout the project, staf were committed to
engaging with risky drinkers and appeared to have been learning-by-doing. Conclusions. Te results indicated a positive attitude to
alcohol prevention work but staf lack knowledge and confdence in the area. Te more practical experience during the study is, the
more confdence seems to have been gained. Tis adds new knowledge to the science of implementation studies concerning alcohol
prevention measures, which have otherwise shown disappointing results, emphasizing the importance of learning in practice.
1. Introduction
Although the efcacy and efectiveness, as well as the cost-
efectiveness, of screening and brief alcohol interventions
(SBI) have been shown to be strong, the implementation of
SBI into routine care practice has not been satisfactory; it
seems to be difcult to motivate health care professionals to
deliver SBI [1–6]. Many implementation projects have tried
to overcome known barriers such as lack of time, resources,
training, and negative attitudes to working with SBI with
limited success [4, 5, 7–9]. In a survey in the United King-
dom comparing role security and therapeutic commitment
between 1999 and 2009 among general practitioners (GPs),
it was seen that the main issue was lack of therapeutic
commitment [6]. Te study also highlighted that lack of time
and resources rather than negative attitudes was related to the
lack of therapeutic commitment to SBI. Implementation of
new methods has repeatedly been shown to need more than
simple training sessions to be efective [4, 10]. Implementa-
tion research suggests that a multifaceted strategy addressing
several barriers may be more efective than simple training
sessions. In addition, implementation eforts involving more
professionals than GPs can improve how professionals work
together towards increased SBI activities [4, 10, 11].
In a recent study from fve European countries involving
120 primary care units, no evidence that SBI rates were
infuenced by role security or therapeutic commitment was
found [12]. Other factors, not specifcally studied, such as
clinical priorities and management support might be more
important for implementation. Tis study underlines a review
by Nilsen et al. [13], which concluded that motivation to
engage in SBI should be viewed as a dynamic process
encompassing the characteristics of the individual health
professional, the patients, the clinical setting, and the wider
context.
Tus, there is a knowledge gap on how to engage primary
care staf in brief alcohol advice. How do we overcome the
perceived lack of knowledge and reluctance to ask patients
about their alcohol habits? Tentative answers might be found
by giving ofce-based support material and management
support rather than trying to change already positive attitudes
among staf [4, 10]. How staf’s performance changes over
Hindawi Publishing Corporation
Journal of Addiction
Volume 2016, Article ID 4731571, 9 pages
http://dx.doi.org/10.1155/2016/4731571